Provider Demographics
NPI:1033437801
Name:WINDWOOD FARM HOME FOR CHILDREN, INC.
Entity Type:Organization
Organization Name:WINDWOOD FARM HOME FOR CHILDREN, INC.
Other - Org Name:RIVERSIDE BEHAVIORAL HEALTH SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:D
Authorized Official - Last Name:MCKELVEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-884-5342
Mailing Address - Street 1:4857 WINDWOOD FARM RD
Mailing Address - Street 2:
Mailing Address - City:AWENDAW
Mailing Address - State:SC
Mailing Address - Zip Code:29429-5951
Mailing Address - Country:US
Mailing Address - Phone:843-884-5342
Mailing Address - Fax:843-884-1287
Practice Address - Street 1:4857 WINDWOOD FARM RD
Practice Address - Street 2:
Practice Address - City:AWENDAW
Practice Address - State:SC
Practice Address - Zip Code:29429-5951
Practice Address - Country:US
Practice Address - Phone:843-884-5342
Practice Address - Fax:843-884-1287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-04
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCRTF-0025323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility